Febrile Nonhemolytic Transfusion Reactions

Abstract

Context.—Febrile nonhemolytic transfusion reactions (FNHTRs) cause unwelcome interruptions during the course of blood product transfusions and necessitate measures to verify the nature of the reaction and to exclude certain dangerous reactions, such as hemolytic and septic phenomena. Objective.—To examine transfusion medicine data to determine the clinical implications of the routine administration of antipyretic medication to adult patients before transfusion for the prevention of FNHTRs. Design.—A retrospective review was conducted of FNHTR data during 5 years (1998–2002), and a determination was made of the cost of a transfusion complicated by an FNHTR. In addition, a comparative cost analysis was performed using our data and published data on the incidence of FNHTRs. The clinical implications of medication with respect to possible drug-induced adverse effects were assessed, as well as the potential interference with diagnosing other forms of transfusion reactions and the mitigation of the clinical effect of an FNHTR. Results.—For nearly 120 000 U of transfused blood components, approximately 80% of which were preceded by antipyretic medication during the study period, the overall incidence of FNHTR was found to be 0.09%. Furthermore, there was no evidence of antipyretic-associated complications, nor any evidence that antipyretics prevented the recognition of other more dangerous complications of transfusions. Conclusion.—Our findings indicate that this practice provides significant advantages to the recipient of a transfusion, but does not appear to yield significant cost benefits for the health care provider.

Association of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS) Part 2: Prevention and monitoring

“…However, this was a small trial, and only 21 patients (7 in the active drug group, and 14 in the placebo group) experienced febrile events 147 . The other study supporting the PICO question was a single‐center retrospective case series with no control group (LOE 6, poor) 148 …”

“…147 The other study supporting the PICO question was a single-center retrospective case series with no control group (LOE 6, poor). 148 Two randomized placebo controlled trials oppose the PICO question (LOE 6, good), although are confounded by the concurrent use of an antihistamine with an antipyretic in the premedication arms. 149,150 A single-center study included 55 hematology/oncology patients, that received 98 leukoreduced, irradiated, single-donor apheresis platelet transfusions.…”

Investigation of the patients with recurrent acute transfusion reactions: A single tertiary medical centre experience

“…A previous study reported a FNHTR rate of 0.09% in 80.0% of patients who received transfusions after routine antipyretic premedication; however, premedication did not prevent other more severe TRs. 16 A Cochrane review of three randomized controlled trials reported no evidence to support the administration of premedication to minimize the risk of non-haemolytic transfusion reactions. 17 The British Committee for Standards in Haematology Blood Transfusion Task Force recommends antipyretic premedication for patients with recurrent FNHTR, no antihistamines or steroid premedication for mild recurrent allergic reactions, and consideration of antihistamine prophylaxis for recurrent moderate or severe allergic reactions.…”

Guideline on the investigation and management of acute transfusion reactions

“…Studies suggesting a reduced incidence of febrile reactions in patients premedicated with paracetamol [34][35][36][37] are counterbalanced by studies with negative results. [38][39][40][41][42] Studies on patients with a previous febrile reaction showed no difference in reaction rates compared to those with no previous reaction.…”

“…Reports on prevention of FNHTRs using premedication with paracetamol (acetaminophen), usually in a dose of 500–650 mg, are of inadequate quality, include both primary and secondary prevention, and report contradictory results. Studies suggesting a reduced incidence of febrile reactions in patients premedicated with paracetamol 34–37 are counterbalanced by studies with negative results 38–42 . Studies on patients with a previous febrile reaction showed no difference in reaction rates compared to those with no previous reaction 39,40 .…”